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      Technology-aided programs for post-coma patients emerged from or in a minimally conscious state

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          Abstract

          Post-coma persons in a minimally conscious state (MCS) or emerged/emerging from such state (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions); and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.

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          From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness.

          Functional neuroimaging and electrophysiology studies are changing our understanding of patients with coma and related states. Some severely brain damaged patients may show residual cortical processing in the absence of behavioural signs of consciousness. Given these new findings, the diagnostic errors and their potential effects on treatment as well as concerns regarding the negative associations intrinsic to the term vegetative state, the European Task Force on Disorders of Consciousness has recently proposed the more neutral and descriptive term unresponsive wakefulness syndrome. When vegetative/unresponsive patients show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviours: MCS+ describes high-level behavioural responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS- describes low-level behavioural responses (i.e., visual pursuit, localization of noxious stimulation or contingent behaviour such as appropriate smiling or crying to emotional stimuli). Finally, patients who show non-behavioural evidence of consciousness or communication only measurable via para-clinical testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness.
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            Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson's disease.

            The Microsoft Kinect sensor (Kinect) is potentially a low-cost solution for clinical and home-based assessment of movement symptoms in people with Parkinson's disease (PD). The purpose of this study was to establish the accuracy of the Kinect in measuring clinically relevant movements in people with PD. Nine people with PD and 10 controls performed a series of movements which were measured concurrently with a Vicon three-dimensional motion analysis system (gold-standard) and the Kinect. The movements included quiet standing, multidirectional reaching and stepping and walking on the spot, and the following items from the Unified Parkinson's Disease Rating Scale: hand clasping, finger tapping, foot, leg agility, chair rising and hand pronation. Outcomes included mean timing and range of motion across movement repetitions. The Kinect measured timing of movement repetitions very accurately (low bias, 95% limits of agreement 0.9 and Pearson's r>0.9). However, the Kinect had varied success measuring spatial characteristics, ranging from excellent for gross movements such as sit-to-stand (ICC=.989) to very poor for fine movement such as hand clasping (ICC=.012). Despite this, results from the Kinect related strongly to those obtained with the Vicon system (Pearson's r>0.8) for most movements. The Kinect can accurately measure timing and gross spatial characteristics of clinically relevant movements but not with the same spatial accuracy for smaller movements, such as hand clasping. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.
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              The JFK Coma Recovery Scale--Revised.

              The JFK Coma Recovery Scale (CRS) was developed to help characterise and monitor patients functioning at Rancho Levels I-IV and has been used widely in both clinical and research settings within the US and Europe. The CRS was recently revised to address a number of concerns emanating from our own clinical experience with the scale, feedback from users and researchers as well as the results of Rasch analyses. Additionally, the CRS did not include all of the behavioural criteria necessary to diagnose the minimally conscious state (MCS), thereby limiting diagnostic utility. The revised JFK Coma Recovery Scale (CRS-R) includes addition of new items, merging of items found to be statistically similar, deletion or modification of items showing poor fit with the scale's underlying construct, renaming of items, more stringent scoring criteria, and quantification of elicited behaviours to improve accuracy of rating. Psychometric properties of the CRS-R appear to meet standards for measurement and evaluation tools for use in clinical and research settings, and diagnostic application suggests that the scale is capable of discriminating patients in the minimally conscious state from those in the vegetative state.
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                Author and article information

                Contributors
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                05 December 2014
                2014
                : 8
                : 931
                Affiliations
                [1] 1Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
                [2] 2Medical College of Georgia, Georgia Regents University Augusta, GA, USA
                [3] 3Department of Special Education, University of Texas at Austin Austin, TX, USA
                [4] 4Department of Educational Psychology, Victoria University of Wellington Wellington, New Zealand
                [5] 5Department of Psychology, “Sapienza” University of Rome Rome, Italy
                [6] 6S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy
                [7] 7Lega F. D’Oro Research Center Osimo, Italy
                [8] 8ISPE Medical Care Center Mola di Bari, Bari, Italy
                Author notes

                Edited by: Srikantan S. Nagarajan, University of California, San Francisco, USA

                Reviewed by: Charles Patrick Gilman, Nazarbayev University, Kazakhstan; Giulia Liberati, Université Catholique de Louvain, Belgium

                *Correspondence: Giulio E. Lancioni, Department of Neuroscience and Sense Organs, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy e-mail: giulio.lancioni@ 123456uniba.it

                This article was submitted to the journal Frontiers in Human Neuroscience.

                Article
                10.3389/fnhum.2014.00931
                4257021
                9d7fe7d8-16a7-43e5-9b73-55ab60df36d8
                Copyright © 2014 Lancioni, Singh, O’Reilly, Sigafoos, Olivetti Belardinelli, Buonocunto, D’Amico, Navarro, Lanzilotti, Ferlisi and Denitto.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution and reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 September 2014
                : 31 October 2014
                Page count
                Figures: 8, Tables: 2, Equations: 0, References: 93, Pages: 13, Words: 9678
                Categories
                Neuroscience
                Clinical Case Study Article

                Neurosciences
                technology-aided programs,minimally conscious state (mcs),emergence from mcs,leisure stimuli,social stimuli,news,choice

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